Department of Radiology and Clinical Research Institute, Seoul National University Hospital, Seoul National University Medical Research Center, Yongon-dong, Chongno-gu, Republic of Korea.
AJR Am J Roentgenol. 2011 Mar;196(3):723-9. doi: 10.2214/AJR.10.4615.
The purpose of this study is to retrospectively assess the upgrade rate determined by surgery for sonographically detected benign papillomas at core needle biopsy.
Sixty-four benign papillomas, detected during screening ultrasound and diagnosed at ultrasound-guided core needle biopsy in 58 patients (mean age, 44.6 years; range, 30-67 years), were surgically excised. The upgrade rate to atypical lesion and malignancy was determined on a per-lesion basis. Statistical analysis was performed to evaluate whether patients' age and lesion variables (i.e., size, distance from the nipple, and ultrasound findings) affected the upgrade rate.
Surgical excision revealed the presence of benign papillomas in 43 cases, no residual lesion in 12 cases, atypical papillomas in seven cases, and papillary ductal carcinoma in situ in two cases. The upgrade rates to atypical papilloma and to malignancy were 10.9% (7/64; 95% CI, 4.51-21.3%) and 3.1% (2/64; 95% CI, 0.38-10.8%), respectively. Mean lesion size was significantly larger for lesions that were upgraded to malignancies (1.4 cm vs 0.9 cm) (p = 0.04). Age, distance from the nipple, and ultrasound findings were not significantly associated with underestimation of atypical lesions or malignancies after excision (p > 0.05).
Our results show that the upgrade rate to malignancy determined by surgery for ultrasound-detected benign papillomas at core needle biopsy was 3.1% (2/64). Accordingly, for the accurate diagnosis of ultrasound-detected benign papillomas at core needle biopsy, surgical excision is recommended.
本研究旨在回顾性评估超声引导下经皮穿刺活检诊断为良性乳突状瘤患者的手术升级率。
对 58 例（年龄 30-67 岁，平均年龄 44.6 岁）患者的 64 个超声筛查发现的良性乳突状瘤进行了手术切除。根据病变情况确定非典型病变和恶性病变的升级率。通过统计分析评估患者年龄和病变变量（即大小、距乳头的距离和超声表现）是否影响升级率。
手术切除发现 43 例为良性乳突状瘤，12 例无残留病变，7 例为非典型乳突状瘤，2 例为乳头导管原位癌。非典型乳突状瘤和恶性病变的升级率分别为 10.9%（7/64；95%CI，4.51-21.3%）和 3.1%（2/64；95%CI，0.38-10.8%）。升级为恶性肿瘤的病变平均大小明显大于非典型病变（1.4cm 与 0.9cm）（p=0.04）。年龄、距乳头的距离和超声表现与切除后非典型病变或恶性肿瘤的低估无显著相关性（p＞0.05）。
我们的结果表明，超声引导下经皮穿刺活检诊断为良性乳突状瘤患者的手术恶性升级率为 3.1%（2/64）。因此，为了准确诊断超声发现的良性乳突状瘤，建议进行手术切除。
